• Title/Summary/Keyword: conservative treatment

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Result of Radiation Therapy of Sino-nasal Cancers Using Partial Attenuation Filter (투과성 필터를 이용하여 방사선 치료를 받은 부비동 및 비암의 치료 결과)

  • Kim, Jin-Hee;Kim, Ok-Bae;Choi, Tae-Jin
    • Radiation Oncology Journal
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    • v.25 no.2
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    • pp.118-124
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    • 2007
  • [ $\underline{Purpose}$ ]: This study was to evaluate the survival and pattern of failure after radiation therapy of sino-nasal cancer using partial attenuation filer and wedged beams and to help radiotherapy planning of sino-nasal cancer. $\underline{Materials\;and\;Methods}$: Between February 1992 and March 2003, 17 patients with sino-nasal cancers underwent radiation therapy using partial attenuation filter at Dongsan Medical Center, Keimyung university. There were 9 male and 8 female patients. Patients' age ranged from 40 to 75 years (median 59 years). There were 10 patients of maxillary sinus cancer, 7 patiens of nasal cancer. The histologic type was squamous cell carcinoma in 11, adenoid cystic carcinoma in 4 and olfactory neuroblastoma in 2. The distribution of clinical stage by the AJCC system was 3 for stage II, 7 for III and 6 for IV. The five patients were treated with radiation alone and 12 patients were treated with surgery and postoperative radiation therapy. The range of total radiation dose delivered to the primary tumor was from 44 to 76 Gy (median 60 Gy). The follow-up period ranged from 3 to 173 months with median of 78 months. $\underline{Results}$: The overall 2 year survival rate and disease free survival rate was 76.4%. The 5 year and 10 year survival rate were 76.4% and 45.6% and the 5 year and 10 year disease free survival rate was 70.6%. The 5 year disease free survival rate by treatment modality was 91.6% for postoperative radiation group and 20% for radiation alone group, statistical significance was found by treatment modality (p=0.006). There were no differences in survival by pathology and stage. There were local failure in 5 patients (29%) but no distant failure and no severe complication required surgical intervention. $\underline{Conclusion}$: Radiation therapy of sino-nasal cancer using partial attenuation filter was safe and effective. Combined modality with conservative surgery and radiation therapy was more advisable to achieve loco-regional control in sino-nasal cancer. Also we considered high precision radiation therapy with dose escalation and development of multi-modality treatment to improve local control and survival rate in advanced sino-nasal cancer.

Treatment of Osteochonritis Dissecans of Femoral Condyle (대퇴골과 박리성 골연골염의 치료)

  • Lee Dong-Chul;Kwon Soon;Son Wook-Jin
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.49-54
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    • 2002
  • Purpose : To analyze the clinical results of treatment for the osteochondritis dissecans of femoral condyle by age, the type of lesion and method of treatment. Methods : From March 1991 to February 2000, 17 patients (20 cases) with osteochondritis dissecans of the femoral condyle were followed up over 1 year. Three patients had bilateral lesion. There were 12 cases with trauma history (9 cases with sports injury and 3 cases with direct trauma). The initial symptoms were pain, clicking, locking, giving way in the order of frequency, pain was revealed in all cases. Clinical evaluation of IKDC and Hughston method were used for subjective and objective function. Results : The number of male patient was 12, and the mean age was 19.8 year old (11$\~$50). The location of the lesion was 14 cases in medial femoral condyle and 6 cases in lateral femoral condyle. The arthroscopic findings of the lesion in 15 cases were as follows, early separation in 6 cases, partially detachment in 4 cases, and crators and complete detachment in 5 cases. 5 cases were treated with mutiple drilling and 5 cases with Herbert screw fixation, 3 cases with Herbert screw fixation and bone graft. In early stage, 7 cases were treated with conservative method. In the grading of Hughston score, 6 cases were graded as excellent, 9 cases as good, 15 cases were graded as good to excellent. Based on the IKDC scale, 1 case was graded as normal, 6 as nearly normal, and 10 as abnormal. Conclusions : The trauma seemed to be important factor in occurrence of osteochondritis dissecans of the femoral condyle. The clinical results of juvenile period showed better than adolescence and adult period, it is necessary to detect the lesion as soon as possible. The result of subjective evaluation was worse than the Hughston evaluation. It was caused by limiting involvement of sports activity and limited activity in the adolescence.

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The Effectiveness of Buprenorphine Transdermal Patch on Patients with Shoulder Pain: Short-Term Follow-up Study (견관절 통증을 동반한 동결견 환자에게서 Buprenorphine transdermal patch의 효과: 단기 추시 결과)

  • Hong, Jin Ho;Park, Yong Bok;Ryu, Ho Young;Jeon, Sang Jun;Park, Won Ha;Yoo, Jae Chul
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.7-12
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    • 2014
  • Purpose:The effectiveness of transdermal buprenorphine patch on the patients with frozen state of frozen shoulder was evaluated. Materials and Methods: Between March and September in 2013, 127 patients with pain and limited range of motion in shoulder joint over 6 months were included. Every patient was confirmed the diagnosis through MRI or ultrasonogram and each patient received intra-articular injection of steroid once. After 2~4 weeks, every patient was interviewed via telephone survey and finally 105 patients were included, 54 patients received only oral NSAIDs (NP group) while 51 patients received additional transdermal buprenorphine patch (BP group). Pain and functional visual analog scale (PVAS, FVAS), American Shoulder Elbow Society (ASES) score was checked. Results: Generally, every outcome variables showed improvements in both groups (p<0.001). PVAS score after treatment showed superior result in NP group but it was not significant (p=0.088). In ASES score, NP group had superior result than BP group and it had significant difference. Similarly in FVAS, NP group showed superior result but the data before treatment was significantly different (p=0.028) Conclusion: Transdermal buprenorphine patch didn't show superior treatment result in the patient with frozen state of frozen shoulder which was applied with oral NSAIDs after single intra-articular glenohumeral steroid injection in short-term follow-up.

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Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor (족관절 내과 절골술 및 대형신연기를 이용한 제3형 거골 경부 골절의 치료 결과)

  • Park, Sung Hae;Lee, Jun Young;Lee, Jung Woo
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.45-51
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    • 2019
  • Purpose: The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively. Materials and Methods: From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed. Results: In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases. Conclusion: An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

Two Patients of Acute Liver Damage following the Ingestion of a Sea Hare Eggs (군소 알을 섭취한 후 발생한 급성 독선간염 2예)

  • Lee, Won-Jae;Lim, Hyun-Sul
    • Journal of agricultural medicine and community health
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    • v.30 no.2
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    • pp.241-249
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    • 2005
  • Herein, two patients of acute toxic hepatitis occurred to persons had eaten Aplysia kurodai and their eggs. The authors report 2 patients of acute toxic hepatitis with reviews of the clinical features. One patient had gathered Aplysia kurodai and it's eggs from Ulleungdo sea shore on May 17, 2003. He ate with boiling the eggs. This patient developed acute toxic hepatitis and symptoms of aplysianin poisoning, such as abdominal pain, nausea, vomiting and watery diarrhea about 10 and half hours after ingestion. The other patient had gathered Aplysia kurodai and its egg from Ulleungdo sea shore on 16 May 2004, which were consumed without boiling the eggs. This patient developed acute toxic hepatitis and symptoms of aplysianin poisoning, such as abdominal pain, nausea, vomiting and watery diarrhea, about 10 and half hours after ingestion. This patient complained of jaundice and pruritus, about 10 days after ingestion. The 2 patients all improved within 15~25 days with conservative treatment. This is the first significant report of acute toxic hepatitis caused by aplysianin poisoning following the consumption of Aplysia kurodai and their eggs in Korea. The clinical features, management and preventive counterplan of acute toxic hepatitis caused by aplysianin poisoning are also presented.

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SPONTANEOUS ERUPTION GUIDANCE OF UNERUPTED TOOTH AFTER SURGICAL REMOVAL OF COMPLEX ODONTOMA (복잡 치아종의 외과적 적출후 미맹출치의 자발적 맹출 유도)

  • Park, Sung-Youn;Nam, Dong-Woo;Kim, Hyun-Jung;Kim, Young-Jin;Nam, Soon-Hyeun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.3
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    • pp.489-494
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    • 2003
  • Odontomas are the common type of odontogenic tumors and generally they are asymptomatic, depending upon size, location and their limited growth potential. they are rarely diagnosed before the second decade of life, and the frequently lead to impaction or delayed eruption of permanent teeth. Odontomas are classified of compound as compound or complex by morphology. Complex odontomas are unorganized masses of odontogenic tissues, morphologically not resembling the teeth, account for approximately 25 percent of all odontomas, 22 percent of odontogenic tumor of the jaws, and have a predilection for the posterior mandible in males. The etiology of odontomas is unknown, although local trauma, infection, and genetic factors have been suggested. Usually, treatment of odontoma is conservative sugical removal and their is little probability of recurrence. This paper describes two cases of complex odontomas diagnosed in children due to impaction of maxillary first molar in all cases, the surgical excision of the lesions was performed. Follow-up after 2 years, showed spontaneous eruption of the first permanent molar to the occlusal plane.

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Appropriateness Evaluation of Hospitalization for the Cerebral Ischemia Patients (허혈성 뇌졸중 환자의 재원적절성 평가)

  • Yoem, Hyo-Young;Kim, Soon-Lae
    • Research in Community and Public Health Nursing
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    • v.10 no.1
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    • pp.80-92
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    • 1999
  • The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

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PERIPHERAL ODONTOMA IN A CHILD: CASE REPORT (소아에서 발생한 변연성 치아종의 증례보고)

  • Lee, Young-Ho;Park, Ho-Won;Lee, Ju-Hyun;Seo, Hyun-Woo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.39 no.3
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    • pp.301-305
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    • 2012
  • The odontoma is a hamartoma of odontogenic origin and consists of enamel, dentin, cementum and pulp tissue. Two types of odonotma are histologically recognized: complex and compound. Odontoma may be the cause of noneruptoin or impaction of teeth, formation of cyst and resorption of adjacent bone. The recommended treatment for an odontoma is conservative surgical excision. No propensity for recurrence has been noted. Peripheral odontoma is relatively rare lesion and shows the histological characteristics of an intraosseous odontoma. This report described a 3-year-old Korean girl with a firm gingival mass in the posterior mandibular area, which had been gradually enlarging over 18months. Radiographic examination showed a radiopaque mass but no evidence of underlying intraosseous lesion. Excisional biopsy was performed for the mass removal and histopathological examination. The result of histopathological study was identified as hamartous supernumerary tooth germ. Based on the clinical presentation, radiographic and histopathologic findings, we concluded that the final diagnosis was peripheral odontoma. For three years after surgery, there is no clinical sign of recurrence.

THE ANTICARIOGENIC EFFECT OF RESIN INFILTRATION ACCORDING TO THE PRETREATMENT OF SURFACE LAYERS IN NATURAL INCIPIENT CARIES LESIONS (초기 우식 병소의 표층 처리에 따른 Resin infiltration의 우식 저지 능력 평가)

  • Kim, Min-Jeong;Lee, Dong-Soo;Kim, Shin;Jeong, Tae-Sung
    • Journal of the korean academy of Pediatric Dentistry
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    • v.37 no.4
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    • pp.412-421
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    • 2010
  • As a most conservative, minimally invasive trial against early caries lesions, resin infiltration concept has been introduced and studied mainly about effective materials and pre-treatment methods of surface layers to arrest the lesion effectively, which is still going on. This study was performed with an aim of evaluating the efficacy of arresting the caries process in the natural incipient lesions in spite of removing the surface layers and we obtained the results as follows: 1. It was revealed that infiltration groups(1, 3, 5) showed lower radio-density decline between pre- and posttreatment than control groups(2, 4, 6)(p<0.05). 2. Group 5, in which the surface layer was removed with hydrochloric acid, showed the most significant anticariogenic effect(p<0.05). 3. Under SEM evaluation after infiltration, group 1 and 3 showed more irregular destruction and intensive loss of surface layers than group 5. In conclusion, it was thought resin infiltration can be an effective tool against the early caries lesions although surface layers are removed.

A Case of Acute Myeloid Leukemia with Multilineage Dysplasia accompanying Malignant Pleural Effusion (악성흉막삼출액을 동반한 다계열형성이상 급성골수백혈병 1예)

  • Seo, Young Ik;Choi, Tae Youn;Shin, Jeong Won;Won, Jong Ho;Lee, Sang-Cheol;Park, Hee-Sook;Lee, Nam-Soo;Park, Rojin
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.1
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    • pp.49-51
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    • 2008
  • We report a case of acute myeloid leukemia with multilineage dysplasia accompanying malignant pleural effusion. A 73 year-old male patient was admitted complaining of febrile sensations and right chest pain. The cytology of the pleural fluid revealed malignant pleural effusion showing many blasts, which had previously been identified in his bone marrow when he was diagnosed with acute myeloid leukemia with multilineage dysplasia two months earlier. His age and poor general condition had precluded chemotherapy with the exception of hydroxyurea and conservative treatment. Unfortunately, he succumbed to the disease 4.5 months after diagnosis. This case highlights the importance of determining if the pleural effusion of acute leukemia is malignant or not because it can suggest a pleural metastasis and influence the prognosis.